Knee prosthesis assembly with ligament link

ABSTRACT

A prosthetic knee joint assembly includes a femoral component and a bearing that supports articulation of the femoral component. The assembly further includes a tibial tray. Furthermore, the assembly includes a ligament link operably coupled to the tibial tray or the femoral component via a coupling component. The ligament link extending through the other of the tibial tray or the femoral component to couple to the respective one of the femur or tibia. The ligament link extends between first and second ends and includes an outer wall defining an interior longitudinal passage portion. First and second apertures extend through the wall. The first end extends through the first and second apertures and the longitudinal passage portion to define a first adjustable loop, and the second end extends through the first and second apertures and the longitudinal passage portion to define a second adjustable loop.

CROSS REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application No.61/181,938, filed on May 28, 2009, the entire disclosure of which isincorporated herein by reference.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/489,168 filed on Jun. 22, 2009, which is acontinuation-in-part of U.S. patent application Ser. No. 12/474,802filed on May 29, 2009, which is a continuation-in-part of (a) U.S.patent application Ser. No. 12/196,405 filed on Aug. 22, 2008; (b) U.S.patent application Ser. No. 12/196,407 filed on Aug. 22, 2008; (c) U.S.patent application Ser. No. 12/196,410 filed on Aug. 22, 2008; and (d) acontinuation-in-part of U.S. patent application Ser. No. 11/541,506filed on Sep. 29, 2006, which is now U.S. Pat. No. 7,601,165 issued onOct. 13, 2009.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/570,854 filed on Sep. 30, 2009, which is acontinuation-in-part of (a) U.S. patent application Ser. No. 12/014,399filed on Jan. 15, 2008; and (b) U.S. patent application Ser. No.12/014,340 filed on Jan. 15, 2008.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/702,067 filed on Feb. 8, 2010, which is a continuation ofU.S. patent application Ser. No. 11/541,505 filed on Sep. 29, 2006 andis now U.S. Pat. No. 7,658,751 issued on Feb. 9, 2010.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/196,398 filed Aug. 22, 2008, which is a continuation-in-partof U.S. patent application Ser. No. 11/784,821 filed Apr. 10, 2007.

The disclosures of all the above applications are incorporated byreference herein.

FIELD

The following relates to a knee prosthesis assembly and, moreparticularly, to a knee prosthesis assembly with a ligament link.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

Prosthetic joints can reduce pain due to arthritis, anatomicaldeterioration, deformation, and the like. By replacing or strengtheningthe anatomy, prosthetic joints can improve mobility of the joint.

Anatomical knee joints may leave intact a plurality of anatomicalligaments, which extend between and connect the bones of the knee joint.In some cases, the prosthetic knee joint can be implanted, leaving oneor more of these anatomical ligaments intact. In other cases, if ananatomical ligament is compromised, the ligament is removed and a moreconstrained prosthetic knee joint is implanted.

In other instances where there is only soft tissue damage, an end of ananatomical ligament that has become disconnected from bone can bereattached to the bone with a fastener. Also, in some cases, theanatomical ligament can be resected and at least a portion of theresected ligament can be replaced by an autograft, allograft, xenograft,or artificial graft. These grafts can be attached to a remaining portionof the anatomical ligament and/or to bone using a fastener, etc.

The following disclosure relates to a knee prosthesis assembly thatrestores function of a resected and/or removed anatomical ligament. Theknee prosthesis assembly of the present disclosure can be quickly andconveniently implanted.

SUMMARY

A prosthetic knee joint assembly for a knee joint with a tibia and afemur is disclosed. The assembly includes a femoral component thatengages the femur and at least one bearing that supports articulation ofthe femoral component thereon. Also, the assembly includes a tibial traythat supports the bearing and engages the tibia. The assembly alsoincludes a ligament link coupling component included on the femoralcomponent or the tibial tray. The assembly additionally includes aligament link operably coupled to the one of the tibial tray or thefemoral component via the ligament link coupling component. The ligamentlink also extending through the other of the femoral component or thetibial tray to operably couple to the respective one of the femur or thetibia. The ligament link extends from a first end to a second end, andthe ligament link has an outer wall defining an interior longitudinalpassage portion. The ligament link also has a first aperture passingthrough the outer wall and disposed between the first and second ends,the ligament link additionally has a second aperture passing through theouter wall and disposed between the first and second ends. The first endextends through the first and second apertures and the longitudinalpassage portion to define a first adjustable loop, and the second endextends through the first and second apertures and the longitudinalpassage portion to define a second adjustable loop.

A method of implanting a prosthetic knee joint assembly is alsodisclosed. The method includes operably coupling a femoral component ofthe knee joint assembly to a femur of a patient. The method alsoincludes operably coupling a tibial component of the knee joint assemblyto a tibia of the patient. Furthermore, the method includes operablycoupling a ligament link to one of the femur or the tibia. In addition,the method includes operably coupling the ligament link directly to oneof the tibial component or the femoral component via a ligament linkcoupling component included on the one of the tibial component or thefemoral component. The ligament link extends from a first end to asecond end, and the ligament link has an outer wall defining an interiorlongitudinal passage portion. The ligament link also has a firstaperture passing through the outer wall and disposed between the firstand second ends, the ligament link additionally has a second aperturepassing through the outer wall and disposed between the first and secondends. The first end extends through the first and second apertures andthe longitudinal passage portion to define a first adjustable loop, andthe second end extends through the first and second apertures and thelongitudinal passage portion to define a second adjustable loop.

Still further, a prosthetic knee joint assembly for a knee joint of apatient with a tibia and a femur is disclosed. The prosthetic knee jointassembly includes a femoral component that engages the femur. Thefemoral component includes a medial and lateral condyle portionconnected by a patellar track portion as well as an intercondylaropening defined between the medial and lateral condyle portions. Also,the assembly includes at least one bearing that supports articulation ofat least one of the medial and lateral condyle portions thereon.Moreover, the assembly includes a tibial tray that supports the bearingand that engages the tibia. The tibial tray includes a plurality ofcoupling components, and the coupling components are disposed on ananterior portion of the tibial tray. The coupling components aredisposed on opposite sides of a medial plane of the tibial tray.Additionally, the assembly includes a ligament link operably coupled tothe tibial tray via the coupling component. The ligament link is alsooperable to couple to the femur. The ligament link extends through theintercondylar opening, and the ligament link extends from a first end toa second end. The ligament link has an outer wall defining an interiorlongitudinal passage portion, and the ligament link also includes afirst aperture passing through the outer wall and disposed between thefirst and second ends. The ligament link also includes a second aperturepassing through the outer wall and disposed between the first and secondends. The first end extends through the first and second apertures andthe longitudinal passage portion to define a first adjustable loop and afirst free end. The second end extends through the first and secondapertures and the longitudinal passage portion to define a secondadjustable loop and a second free end. The first and second free endsare pullable to increase a tension in the ligament link.

Moreover, a prosthetic knee joint assembly for a knee joint of a patientwith a tibia and a femur is disclosed. The prosthetic knee jointassembly includes a femoral component that engages the femur. Thefemoral component includes a first condylar portion and a secondcondylar portion separated at a distance apart to define anintercondylar opening. The femoral component includes a ligament linkcoupling component extending from at least one of the first and secondcondylar portions into the intercondylar opening. Additionally, theassembly includes at least one bearing that supports articulation of thefemoral component thereon and a tibial tray that engages the tibia. Thetibial tray includes a superior surface that supports the bearingthereon, and the tibial tray includes an opening. Furthermore, theassembly includes a ligament link operably coupled to the femoralcomponent via the coupling component. The ligament link also extendsthrough the opening to operably couple to the tibia. Additionally, theligament link extends from a first end to a second end and has an outerwall defining an interior longitudinal passage portion. The ligamentlink includes a first aperture passing through the outer wall anddisposed between the first and second ends. The ligament link alsoincludes a second aperture passing through the outer wall and disposedbetween the first and second ends. The first end extends through thefirst and second apertures and the longitudinal passage portion todefine a first adjustable loop and a first free end. Also, the secondend extends through the first and second apertures and the longitudinalpassage portion to define a second adjustable loop and a second freeend. The first and second free ends are pullable to increase a tensionin the ligament link.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 is an anterior perspective view of a knee prosthesis assemblyaccording to various exemplary embodiments of the present disclosure;

FIG. 2 is a posterior perspective view of the knee prosthesis of FIG. 1;

FIG. 3 is a lateral perspective view of a femoral component of the kneeprosthesis of FIG. 1;

FIG. 4 is a superior perspective view of a tibial tray of the kneeprosthesis of FIG. 1;

FIG. 5 is an inferior perspective view of the tibial tray of FIG. 4;

FIG. 6 is a perspective view of a mobile bearing of the knee prosthesisof FIG. 1;

FIG. 7 is a perspective view of a fixed bearing of the knee prosthesisof FIG. 1;

FIG. 8 is a perspective view of a locking bar associated with the fixedbearing of a knee prosthesis of FIG. 1;

FIG. 9 is a partially exploded posterior view of a knee prosthesisconstructed in accordance to additional features of the presentteachings;

FIG. 10 is a posterior perspective view of the knee prosthesis of FIG.9;

FIG. 11 is an anterior perspective view of a tibial tray and fixedbearing portion of the knee prosthesis of FIG. 10;

FIG. 12 is a perspective view of a mobile bearing that slidablycooperates within a pocket formed on the fixed bearing of FIG. 11;

FIG. 13 is a perspective view of a knee prosthesis constructed inaccordance to additional features of the present teachings;

FIG. 14 is a top view of a tibial tray of the knee prosthesis of FIG. 13according to various other exemplary embodiments;

FIG. 15 is a top view of a tibial tray of the knee prosthesis of FIG. 13according to various other exemplary embodiments;

FIGS. 16A and 16B are top views of a portion of a ligament linkaccording to various embodiments for the knee prosthesis of the presentteachings, wherein FIG. 16A shows the portion in an unlooped state andFIG. 16B shows the portion in a looped state;

FIG. 17 is a section view of the knee prosthesis of FIG. 13 according tovarious other exemplary embodiments;

FIG. 18 is an environmental view of the knee prosthesis of FIG. 13 witha partial cutway of a femur according to various other exemplaryembodiments;

FIG. 19 is an exploded, perspective view of another knee prosthesisassembly according to additional embodiments of the present disclosure;

FIG. 20 is a cross sectional view of the knee prosthesis assembly ofFIG. 19; and

FIG. 21 is a cross sectional view of the tibial component of the kneeprosthesis assembly of FIG. 19 taken along the line 21-21.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.

With initial reference to FIGS. 1 and 2, a knee prosthesis assemblyconstructed in accordance to one example of the present teachings isshown and generally identified at reference numeral 10. The kneeprosthesis assembly 10 can generally include a femoral component 12, atibial tray 14, a first bearing 16 (a medial bearing), and a secondbearing 18 (a lateral bearing). As will be described, the kneeprosthesis assembly 10 can be used when it is desirable to retain orreconstruct an anterior cruciate ligament (ACL) and/or a posteriorcruciate ligament (PCL). Although the illustrated prosthesis assembly 10is intended for a left knee of a patient, it will be appreciated thatthe prosthesis assembly 10 could include similar features to beconfigured for implantation in a right knee of a patient as well.

The respective components of the knee prosthesis assembly 10 can bepatient specific, such that each component can be constructed foroptimal features for a given patient. For example, the bone interfacemargins of the femoral component 12 and tibial tray 14 can be patientspecific for optimized bone coverage. In addition, the overall size,such as anterior-posterior dimensions and bone cut geometry can bedetermined and used for manufacturing the components of the kneeprosthesis assembly 10. Moreover, some articulation features can bedetermined and used as criteria for forming the components of the kneeprosthesis assembly 10. In sum, each of the components of the kneeprosthesis assembly 10 can be a patient-specific implant, a semi-customimplant or an off-the-shelf or standard production implant. Acustom-made implant is a patient-specific, one-of-a-kind implantspecifically made for a particular patient, and consequently there is noinventory associated with such implant. Standard or off-the-shelfimplants are available and stocked in a number of sizes, typically sixor more, and a number of configurations or types, including bilateral orunilateral implants, constrained, semi-constrained, mobile, etc. Becauseof the variety of sizes and configurations that are kept in stock fordifferent patients, a large inventory of standard implants is created,and several molds for each type and size of implant may be used.Semi-custom implants can provide an intermediate solution betweencustom-made and off-the-shelf implants. Semi-custom implants reduce thesize of inventory and molds required for production, while allowing somedegree of patient-specific customization. Additional description ofpatient-specific implants and semi-custom implants and theirimplementations may be found in copending patent application Ser. No.12/103,824, filed Apr. 16, 2008 and entitled: Method and Apparatus forManufacturing An Implant, the disclosure of which is hereby incorporatedby reference in its entirety.

With additional reference to FIG. 3, the femoral component 12 will nowbe described in greater detail. The femoral component 12 can generallycomprise a cruciate retaining prosthesis and can include variousportions to replace or mimic the distal femur. The femoral component 12can include a medial condyle portion 20 and a lateral condyle portion22. The condyle portions 20, 22 can include a convex, rounded contactsurface that extends generally in an anterior/posterior directionsimilar to anatomical condyles. The condyle portions 20, 22 canrespectively replace the anatomical medial and lateral condyles of adistal femur. The condyle portions 20, 22 can be connected by a patellartrack portion 26. Thus, the femoral component 12 can be generallyU-shaped and curved in the superior direction. The condyle portions 20,22 and patellar track portion 26 can be integrally connected so as to bemonolithic. The patellar track portion 26 can allow for articulation ofa patella (not shown), either natural or prosthetic, once the femoralcomponent 12 is implanted onto the distal femur. The condyle portions20, 22 and the patellar track portion 26 can generally define anexterior portion of the femoral component 12. The femoral component 12can define an intercondylar opening 30 or passage between the medial andlateral condyle portions 20, 22 (i.e., the open and unobstructed areadisposed posteriorly from the patellar track portion 26).

As will be discussed, the opening 30 can accommodate and provideclearance for an anatomical anterior cruciate ligament (ACL) and/or ananatomical posterior cruciate ligament (PCL). Furthermore, as will bediscussed, the opening 30 can accommodate and provide clearance for aligament link (e.g., an autograft, an allograft, a xenograft, anartificial graft, or a combination thereof) for reconstructing andrestoring function of the anatomical ACL and/or PCL.

The femoral component 12 can include a bone contacting or superiorsurface 34 (FIG. 2). The superior surface 34 can include an anteriorsurface 36 that can be substantially flat and formed generally parallelto a pair of posterior surfaces 38 a, 38 b. A pair of intermediatesurfaces 40 a, 40 b are provided generally at an intermediate portion ofthe superior surface 34. A pair of angled anterior transition surfaces42 a, 42 b can generally connect the anterior surface 36 with theintermediate surfaces 40 a, 40 b. Similarly, a pair of angled posteriortransition surfaces 44 a, 44 b can be provided between the respectiveposterior surfaces 38 a, 38 b and the intermediate surfaces 40 a, 40 b.In one example, a threaded boss 50 a, 50 b can be provided on each ofthe intermediate surfaces 40 a, 40 b, respectively. Similarly, athreaded boss 52 a, 52 b can be provided on the posterior surfaces 38 a,38 b, respectively. The bosses 50 a, 50 b, 52 a, 52 b can be optionallyused to threadably couple with various augments (not specifically shown)as necessary.

The femoral component 12 can be formed as a unitary structure and castof a biocompatible high strength alloy, such ascobalt-chromium-molybdenum alloy or similar suitable material. Allsurfaces, which do not contact the femur, can be highly polished toprovide smooth articulating bearing surfaces. The superior surface 34 ofthe femoral component 12 can be roughened or uneven or include porousmaterial to allow bone ingrowth or attachment with bone cement. Otherfeatures of the femoral component 10 can include those associated withthe Oxford® Partial Knee, which is marketed by Biomet, Inc. of Warsaw,Ind.

With reference now to FIGS. 1, 2, 4 and 5, the tibial tray 14 will nowbe described in greater detail. The tibial tray 14 can include agenerally U-shaped body having a medial portion 60 and a lateral portion62. An anterior portion 61 can extend between and can connect to boththe medial and lateral portions 60, 62. The medial, anterior, andlateral portions 60, 61, 62 can be integrally connected so as to bemonolithic. As will be discussed, the open and unobstructed areadisposed posteriorly from the anterior portion 61 and between the medialand lateral portions 60, 62 can provide clearance for an anatomicalanterior cruciate ligament (ACL), an anatomical posterior cruciateligament (PCL), or a ligament link (e.g., an autograft, an allograft, axenograft, an artificial graft, or a combination thereof) forreconstructing and restoring function of the anatomical ACL and/or PCL.

A slot 64 can be defined in the tibial tray 14 generally between themedial, anterior, and lateral portions 60, 61, 62. As with theintercondylar opening 30 of the femoral component 12, the slot 64 of thetibial tray 14 can accommodate and provide a clearance for an anatomicalACL, an anatomical PCL, and/or a ligament link (e.g., autograft,allograft, xenograft, artificial graft, or combination thereof). Inother embodiments that will be discussed, a ligament link can beoperably coupled directly to the tibial tray 14.

During implantation, the tibial tray 14 can be advanced posteriorly,such that the slot 64 can accommodate the anatomical ACL, anatomicalPCL, and/or ligament link. In instances where a ligament link is used toreconstruct the anatomical ACL and/or anatomical PCL, a trial tibialtray (as well as trial bearings, etc.) having corresponding geometriescan be utilized. One suitable configuration is further described incommonly owned in U.S. Pat. No. 7,255,715, issued Aug. 14, 2007, whichis hereby incorporated by reference in its entirety.

The tibial tray 14 can include an inferior bone engaging side 66 (FIG.5) and a superior bearing engaging side 68 (FIG. 4). The medial portion60 of the superior bearing engaging side 68 can include a highlypolished tibial bearing surface 70. A rail 72 can extend in a generallyanterior/posterior direction adjacent to the highly polished tibialbearing surface 70. The lateral portion 62 can include engagingstructure 78 provided on the superior bearing engaging side 68. Theengaging structure 78 can include a pair of posts 80, 82 integrallyformed at an anterior edge thereof. A retaining rail 84 can extendsuperiorly from a posterior edge of the lateral portion 62. The posts80, 82 can both have an anterior groove 86 and a posterior groove 88,respectively. The retaining rail 84 can have a transverse groove 90formed on an inwardly facing surface. The tibial tray 14 can begenerally manufactured of cobalt-chromium-molybdenum alloy or othersuitable biocompatible material. A pair of fins 94 can extend from theinferior bone engaging side 66. While fins 94 are shown operativelyassociated with the tibial tray 14, other structures suitable forengaging a proximal tibia can include pegs, posts or porous material canadditionally or alternatively be provided on the inferior bone engagingside 66.

The bearings 16, 18 will now be discussed in greater detail. In theembodiments shown in FIGS. 1 and 2, the first bearing 16 (medialfloating bearing) is moveably supported by the tibial tray 14, and thesecond bearing 18 (lateral fixed bearing) is fixedly supported by thetibial tray 14. However, it will be appreciated that the first andsecond bearings 16, 18 could both be fixedly supported by the tibialtray 14 without departing from the scope of the present disclosure.Moreover, it will be appreciated that both bearings 16, 18 could bemoveably supported by the tibial tray 14. Additionally, while theembodiment shown in the figures includes a floating bearing provided ona medial side and a fixed bearing provided on a lateral side, thelocation of these bearings can be swapped. Still further, it will beappreciated that the assembly 10 could include a single, monolithicbearing (floating or fixed) that extends across each of the medial,anterior, and lateral portions 60, 61, 62 of the tibial tray 14 whilestill providing clearance for the slot 64 without departing from thescope of the present disclosure.

With reference to FIGS. 1, 2 and 6, the embodiment of the first bearing16 will now be described in greater detail. The first bearing 16 has asubstantially planar inferior bearing surface 100 which slidably movesand articulates relative to the highly polished tibial bearing surface70. The first bearing 16 further includes a first bearing surface 102.The first bearing surface 102 articulates with the medial condyleportion 20 of the femoral component 12. The first bearing 16 can beformed from a surgical grade, low friction, and low wearing plastic,such as ultra high molecular weight polyethylene (UHMWPE) or othersuitable material.

With reference to FIGS. 1, 2 and 7, the second bearing 18 can includeengaging structure 106 formed on an inferior surface for coupling withthe engaging structure 78 provided on the lateral portion 62 of thetibial tray 14. The engaging structure 106 can generally include aposteriorly extending lip 110 and an anterior groove 112. A locking bar114 (FIG. 8) can be slidably inserted through the slot 112 to interlockbetween the respective grooves 86 to capture the second bearing 18 tothe lateral portion 62 of the tibial tray 14. The posteriorly extendinglip 110 can be nestingly received by the retaining rail 84. The secondbearing 18 can include a second bearing surface 120. The second bearingsurface 120 can articulate with the lateral condyle portion 22 of thefemoral component 12. The second bearing 18 can be formed from asurgical grade, low friction and low wearing plastic, such as UHMWPE orother suitable material.

During use, the medial and lateral condyle portions 20, 22 of thefemoral component 12 can articulate on the first and second bearingsurfaces 102, 120 of the respective bearings 16, 18. As can beappreciated, the second bearing 18 is static relative to the tibial tray14 during articulation of the femoral component 12. The first bearing 16is free to slide along the highly polished tibial bearing surface 70 ofthe medial portion 60 of the tibial tray 14. Movement of the firstbearing 16 is limited by an inboard side of the rail 72.

Turning now to FIGS. 9-11, a knee prosthesis assembly constructed inaccordance to additional features of the present teachings is shown andgenerally identified at reference numeral 210. The knee prosthesisassembly 210 can generally include a femoral component 212, a tibialtray 214, a medial side having a fixed bearing 216 that cooperates witha mobile bearing 218 and a lateral side having a fixed bearing 220. Thefemoral component 212 can be constructed similar to the femoralcomponent 12 described above. The fixed bearing 220 can be constructedsimilar to the lateral fixed bearing 18 described above. The mobilebearing 218 can provide articulation that is fully conforming with thefemoral component 212. The mobile bearing 218 can be captured around itsperimeter by a pocket 222 formed by the fixed bearing 216. In this way,the mobile bearing 218 can have a reduced likelihood of becomingdislocated relative to the fixed bearing 216. While the fixed bearing216 and mobile bearing 218 are shown generally associated with thelateral side of the tibial tray 214, such a configuration can beadditionally or alternatively provided on the medial portion of thetibial tray 214. In one example, the mobile bearing 218 can be formed bypolyethylene or polyetheretherketone (PEEK). As shown in FIG. 11, thefixed bearing 216 can have a pair of channels 226 formed thereon forguiding tabs 230 provided on the mobile bearing 218 (FIG. 12).

Referring now to FIG. 13, a knee prosthesis assembly constructed inaccordance to additional features of the present teachings is shown andgenerally identified at reference numeral 310. Components thatcorrespond to the components of the embodiments of FIGS. 1-8 areindicated with corresponding reference numerals increased by 300. Theassembly 310 can incorporate any of the features disclosed inApplicant's co-pending U.S. patent application Ser. No. 12/788,966,filed May 27, 2010, which published as U.S. Patent Publication No.2010/0305698 on Dec. 2, 2010, entitled KNEE PROSTHESIS ASSEMBLY WITHLIGAMENT LINK, and U.S. patent application Ser. No. 12/788,978, filedMay 27, 2010, which published as U.S. Patent Publication No.2010/0292792 on Nov. 18, 2010, entitled PROSTHETIC LIGAMENT SYSTEM FORKNEE JOINT, both of which are filed concurrently herewith, and each ofwhich is incorporated by reference in its entirety.

The knee prosthesis assembly 310 is shown relative to a resectedanatomical femur 313 and a resected anatomical tibia 315, each of whichare shown in phantom. The knee prosthesis assembly 310 can operativelyand moveably couple to the resected anatomical femur 313 and theresected anatomical tibia 315 in order to support movement of the kneejoint.

Also, the prosthesis assembly 310 is shown relative to an anatomicalresected ligament 321, which is shown in phantom. In the embodimentsrepresented in FIG. 13, the ligament 321 can be an anterior cruciateligament (ACL), which is attached to the femur 313 and which has beenresected or otherwise detached from the tibia 315. However, it will beappreciated that the ligament 321 could be of any suitable type, such asa posterior cruciate ligament (PCL), without departing from the scope ofthe present disclosure. It will also be appreciated that the ligament321 could be intraoperatively resected from the tibia 315 while theprosthesis assembly 310 is being implanted, or the ligament 321 could bedetached from the tibia 315 before surgery, due to injury, etc.

As shown in FIG. 13, the prosthesis assembly 310 can also include aligament link 319. The ligament link 319 can be an autograft, anallograft, a xenograft, an artificial graft, or any combination thereof.The ligament link 319 can be flexible, and can withstand relatively hightension. Also, the ligament link 319 can pierce and extend through theligament 321. In other embodiments, the ligament link 319 can operablycouple to the ligament 321 via fasteners (e.g., sutures, and the like).In still other embodiments, the ligament link 319 can be operablycoupled directly to the femur 313 with the ligament 321 eliminatedaltogether. Furthermore, the ligament link 319 can operably couple tothe tibial tray 314 in a manner to be discussed.

The femoral component 312 of the prosthesis assembly 310 can besubstantially similar to the embodiments of FIGS. 1-11. As shown, theintercondylar opening 330 can provide clearance for the ligament 321 andthe ligament link 319.

The bearings 316, 318 can also be substantially similar to theembodiments of FIGS. 1-11. Furthermore, the tibial tray 314 can besubstantially similar to the embodiments of FIGS. 1-11, except thetibial tray 314 can include at least one or more coupling components 317a, 317 b. As will be discussed, the coupling components 317 a, 317 b canoperably couple to the ligament link 319.

The coupling components 317 a, 317 b can have any suitable shape, size,and location on the tibial tray 314. For instance, as shown in FIG. 13,the coupling components 317 a, 317 b can each be grooves or recessesthat are disposed on the anterior portion 361 of the tibial tray 314. Inaddition, the coupling components 317 a, 317 b can be defined in aninferior, anterior edge 323 of the tray 314. Also, as shown in FIG. 17,the coupling components 317 a, 317 b can each have an axis X′ that isdisposed at a positive acute angle, α, relative to a longitudinal axis Xof the tibia 315. Accordingly, the coupling component 317 a, 317 b canbe oriented substantially normal to the force of tension in the ligamentlink 319 as will be discussed in greater detail below.

As shown in FIG. 13, a selected one of the coupling components 317 a,317 b can receive the ligament link 319 and retain the ligament link 319against movement in the medial-lateral direction. For instance, theligament link 319 can loop or wrap around and be received in theselected coupling component 317 a, 317 b. Accordingly, the ligament link319 can maintain necessary tension and can support movement of the kneejoint.

It will be appreciated that the tibial tray 314 can include any numberof coupling components 317 a, 317 b. As shown in the embodimentsillustrated in FIG. 13, there can be two coupling components 317 a, 317b that are spaced apart from each other on opposite sides of a medianplane P of the tibial tray 314. It will be appreciated that the tibialtray 314 can be a universal tibial tray 314 that is suitable forimplantation in either a patient's right knee or a patient's left knee.If the tibial tray 314 is implanted in a left knee, the couplingcomponent 317 a can be used to retain the ligament link 319, and if thetibial tray 314 is implanted in a right knee, the coupling component 317b can be used to retain the ligament link 319.

In additional embodiments represented in FIG. 14, the couplingcomponents 317 a′, 317 b′ can each be through holes. As shown, thecoupling components 317 a′, 317 b′ can have a linear axis and can extendaxially through both the superior side 368′ of the anterior portion 361′of the tibial tray 314′ as well as the inferior side (not specificallyshown in FIG. 14). Thus, the ligament link (not specifically shown inFIG. 14) can extend through either of the coupling components 317 a′,317 b′ in order to operably couple to the tibial tray 314′. Forinstance, the ligament link can extend through the selected couplingcomponent 317 a′, 317 b′ and can be knotted or tied to secure theligament link.

In still other embodiments represented in FIG. 15, the couplingcomponents 317 a″, 317 b″ can each be eyelets that selectively open andclose. It will be appreciated that the coupling component 317 b″ isshown closed, and the coupling component 317 a″ is shown open in theembodiments of FIG. 15. More specifically, the coupling components 317a″, 317 b″ can each include a respective clasp 331 a″, 331 b″. Eachclasp 331 a″, 331 b″ can be hingeably attached at one end to theanterior portion 361″ of the tibial tray 314″. The opposite end of eachclasp 331 a″, 331 b″ can be selectively secured to and detached from theanterior portion 361″ of the tibial tray 314″. When the clasp 331 a″,331 b″ is closed, the respective coupling component 317 a″, 317 b″ cansecure the ligament link (not specifically shown) to the tibial tray314″. On the other hand, when the clasp 331 a″, 331 b″ is open, theligament link can move into the respective coupling component 317 a″,317 b″.

It will be appreciated that the ligament link 319 can be attached to thetibial tray 314 by the manufacturer or by other personnel beforeimplantation surgery. Thus, the assembly 310 can be implanted moreefficiently because the surgeon or other medical professional need notspend time intraoperatively tying knots or otherwise attaching theligament link 319 to the tibial tray 314.

In other embodiments, the surgeon can intraoperatively attach theligament link 319 to the tibial tray 314. For instance, the surgeon canselect a ligament link 319 for implantation from a plurality ofdifferent ligament links 319 based on a desired tension, geometry,material, or other characteristic of the ligament link 319. Then, thesurgeon can intraoperatively attach the ligament link 319 to both theanatomical ligament 321 and the tibial tray 314.

Furthermore, the ligament link 319 can be an optional feature. Forinstance, if the surgeon chooses not to use the ligament link 319 (andassuming that the ligament link 319 is attached to the tibial tray 314by the manufacturer), the surgeon can cut or simply remove the ligamentlink 319 from the tibial tray 314 before attaching the tibial tray 314to the resected tibia 315. Accordingly, the tibial tray 314 can be veryversatile.

Referring now to FIGS. 16A and 16B, additional features of the ligamentlink 419 according to the present teachings will be discussed.Components that correspond with those of the embodiments of FIG. 13 areidentified with corresponding reference numerals increased by 100. Itwill be appreciated that the embodiment of the ligament link 419 shownin FIGS. 16A, 16B can be only a portion of the ligament link of thepresent disclosure.

As shown in FIG. 16A, the ligament link 419 can be elongate and flexibleand can extend from a first end 441 to a second end 443. Furthermore,the ligament link 419 can have an outer wall 439 that defines alongitudinal passage portion 445, which is disposed between the firstand second ends 441, 443. The longitudinal passage portion 445 can behollow. Moreover, the ligament link 419 can include a first aperture 447that extends through the wall 439 and that is disposed between the firstand second ends 441, 443. Moreover, the ligament link 419 can include asecond aperture 449 that extends through the wall 439 and that isdisposed between the first and second ends 441, 443. More specifically,the first aperture 447 can be disposed between the first end 441 and thelongitudinal passage portion 445, and the second aperture 449 can bedisposed between the second end 443 and the longitudinal passage portion445.

As shown in FIG. 16B, the first end 441 can extend through the firstaperture 447, through the longitudinal passage portion 445, and out ofthe longitudinal passage portion 445 via the second aperture 449.Likewise, the second end 443 can extend through the second aperture 449,through the longitudinal passage portion 445, and out of thelongitudinal passage portion 445 via the first aperture 447. As such,the first end 441 can define a first adjustable loop 451 and a firstfree end 453. Likewise, the second end 443 can define a secondadjustable loop 455 and a second free end 457.

The ligament link 419 can be made out of any suitable material, such asa flexible, high-strength, braided material. In some embodiments, someof the fibers in the link 419 can be inelastic while other fibers in thelink 419 can be elastic and resilient. Moreover, in some embodiments,the fibers within the link 419 can have varying diameters. In addition,the ligament link 419 can have any of the various features disclosed inU.S. Patent Application Publication No. 2009/0318961, published Dec. 24,2009, the disclosure of which is hereby incorporated by reference in itsentirety. Additionally, in some embodiments, the fibers within the link419 can have material properties of the type disclosed in U.S. patentapplication Ser. No. 12/788,978, filed May 27, 2010, which published asU.S. Patent Publication No. 2010/0292792 on Nov. 18, 2010, which isentitled PROSTHETIC LIGAMENT SYSTEM FOR KNEE JOINT, which is filedconcurrently herewith, and which is hereby incorporated by reference inits entirety.

As shown in FIG. 17, the ligament link 419 can operably couple to boththe anatomical resected ligament 421 and the tibial tray 414. Forinstance, the ligament link 419 also includes a suture 463 or otherfastener that is attached to the ligament 421. More specifically, thesuture 463 can pierce the ligament 421, and the longitudinal passageportion 445 can extend through the suture 463 and can be folded suchthat both of the adjustable loops 451, 455 extend toward the tibial tray414. The first and second adjustable loops 451, 455 can loop around theanterior portion 461 of the tibial tray 414 and can be retained withinthe coupling component 417 a of the tibial tray 414. In otherembodiments, the ligament link 419 can be coupled directly to theligament 421 without the suture 463. In still other embodiments, oneadjustable loop 451 can loop around the tibial tray 414 while the otheradjustable loop 455 is coupled to the suture 463 or directly to theligament 421.

Subsequently, the first and/or second free ends 453, 457 can be pulledaway from the longitudinal passage portion 445 (as represented by twoarrows in FIG. 17) in order to reduce the size of the adjustable loops451, 455, to pull the ligament 421 toward the tibial tray 414, and toincrease and adjust tension in the ligament link 419. This can beperformed intraoperatively (i.e., during surgery in the operating room).Furthermore, friction between the first and second ends 441, 443 and thelongitudinal passage portion 445 can maintain this adjusted level oftension in the ligament link 419.

Referring now to FIG. 18, additional features of the prosthesis assembly510 will be discussed. Components corresponding to the embodiments ofFIGS. 1-8 are indicated with corresponding reference numerals increasedby 500.

As shown, the ligament link 519 can extend through a bone tunnel 571 inthe femur 513 and can be coupled to the femur 513 via a fastener 573. Insome embodiments, the fastener 573 can be seated against an outer rim575 of the bone tunnel 571. For instance, the fastener 573 can be of atype disclosed in Applicant's co-pending U.S. patent application Ser.No. 12/788,978, filed May 27, 2010, which published as U.S. PatentPublication No. 2010/0292792 on Nov. 18, 2010, which is filedconcurrently herewith, and which is entitled PROSTHETIC LIGAMENT SYSTEMFOR KNEE JOINT, which is filed concurrently herewith, and which ishereby incorporated by reference in its entirety. However, it will beappreciated that the fastener 573 can be of any suitable type withoutdeparting from the scope of the present disclosure. In some embodiments,the surgeon can select the fastener 573 for implantation from aplurality of different fasteners 573, based on the desired location forattaching the ligament link 519, etc.

Accordingly, as shown in FIG. 18, the ligament link 519 can attach tothe femur 513 instead of a resected ligament, as was discussed above inthe embodiments of FIGS. 13 and 17. The opposite end of the ligamentlink 519 can be coupled to the tibial tray 514 similar to theembodiments discussed above. Thus, the ligament link 519 can be receivedin one of the coupling components 517 of the tibial tray 514.

It will also be appreciated that the femoral component 512 and thetibial tray 514 can be implanted, and the ligament link 519 can beattached to the femur 513 and the tibial tray 514 in a single operativeprocedure. Accordingly, the knee joint can be repaired more quickly andefficiently, and the patient's recovery time can be reduced.

Referring now to FIGS. 19-21, additional features of the prosthesisassembly 610 will be discussed. Components corresponding to theembodiments of FIGS. 1-8 are indicated with corresponding referencenumerals increased by 600.

As shown in FIG. 19, the ligament link coupling component 617 can beoperably coupled to (e.g., fixed to) to the femoral component 612. Forinstance, the femoral component 612 can include a first wall 677 a and asecond wall 677 b, each extending superiorly from a respective condyleportion 620, 622. Also, the coupling component 617 can be a rigid rod orbar that is fixed at each end to the condyle portions 620, 622. As such,the coupling component 617 can extend across the intercondylar opening630. It will be appreciated that the ligament link coupling component617 can be of any suitable type other than a rod or bar of the typeillustrated. For instance, in other embodiments, the ligament linkcoupling component 617 can be a through hole defined in the first orsecond walls 677 a, 677 b, and in some embodiments, the through hole canbe reinforced with a grommet-like feature. Also, in some embodiments,the coupling component 617 can be cantilevered within the intercondylaropening 630.

Moreover, the bearing 616 can be a uniform member that is disposedinferior to both condyle portions 620, 622. The bearing 616 can be fixedto the tibial tray 614 using a fastener (e.g., pin, etc.) or in anyother suitable fashion. The bearing 616 can also be moveably supportedon the tray 614 in some embodiments. Furthermore, the bearing 616 caninclude an opening 679 that is disposed inferior to the intercondylaropening 630. The opening 679 can be rounded (e.g., circular, elliptical,etc.), polygonor, or any other shape.

Still further, as shown in FIGS. 19-21, the tibial tray 614 can includeat least one or more openings 681 a, 681 b. The openings 681 a, 681 bcan be through holes. The tibial tray 614 can include any suitablenumber of openings 681 a, 681 b. For instance, in the embodiments shown,the tibial tray 614 can include two openings 681 a, 681 b disposed onopposite sides of a medial plane of the tibial tray and disposed onopposite sides of the stem 683. Also, as shown in FIG. 21, the openings681 a, 681 b can each extend at a positive, acute angle θ relative tothe medial plane P of the tibial tray 614. For instance, each opening681 a, 681 b can extend inferiorly from the superior side 668 of thetibial tray 614 generally away from the medial plane P at the angle θ.Moreover, as shown in FIG. 20, the openings 681 a, 681 b can each extendat a positive, acute angle θ′ relative to a coronal plane P′ of thetibial tray 614.

When assembled (FIG. 20), a ligament link 619 can be operably coupled to(e.g., at least partially wrap around) the coupling component 619. Also,the ligament link 619 can extend through the opening 679 of the bearing616. Likewise, the ligament link 619 can extend through one of theopenings 681 a, 681 b of the tibial tray 614. Still further, theligament link 619 can extend through a bone tunnel 685 formed within thetibia 615 and can operably couple to the tibia 615 via a fastener 673 ofthe type described above.

It will be appreciated that the surgeon or another medical professionalcan choose any one of the openings 681 a, 681 b for receiving theligament link 619. For instance, in the embodiment shown, the ligamentlink 619 passes through the opening 681 a. This decision can be based onvarious factors. For instance, in some embodiments, the opening 681 a isutilized if the prosthesis assembly 610 is implanted in a left leg, andthe opening 681 b is utilized if the prosthesis assembly 610 isimplanted in a right leg.

Also, it will be appreciated that the angles θ, θ′ of the opening 681 a,681 b can allow the ligament link 619 to extend through the opening 681a, 681 b in a relatively straight line. Moreover, it will be appreciatedthat the openings 681 a, 681 b can be positioned on the tibial tray 614such that the ligament link 619 can be routed in a manner thatsubstantially mimics a natural anatomical ligament. However, it will beappreciated that the openings 681 a, 681 b can have any suitablelocation on the tray 614 and can have any suitable shape withoutdeparting from the scope of the present disclosure.

In addition, it will be appreciated that the ligament link 619 canattach to the tibia 615 in any suitable fashion other than the bonetunnel 685 and the fastener 673. For instance, in some embodiments, aresected anatomical ligament (not shown) can remain anatomicallyattached to the tibia 615, and the ligament link 619 can operably couplethe resected anatomical ligament to the femoral component. Morespecifically, in some embodiments, the opening 681 a, 681 b can provideaccess to the resected anatomical ligament.

It will be appreciated that the ligament link 19, 319, 419, 519, 619 caninclude additional sutures, grafts, fasteners, and other components forattachment purposes. For instance, in some embodiments, the ligamentlink 19, 319, 419, 519 can be attached to the tibial tray 14, 314, 414,514 via a suture. Additionally, in some embodiments, the ligament link619 can be attached to the femoral component 612 via a suture. Also, insome embodiments, the ligament link 19, 319, 419, 519 can be attached tothe femur or tibial tray 14, 314, 414, 514 via an autograft or othertype of graft. Furthermore, in some embodiments, the ligament link 619can be attached to the tibia 615 or femoral component 612 via anautograft or other type of graft.

Thus, the knee prosthesis assembly 10, 210, 310, 410, 510, 610 can bequickly and conveniently implanted. The ligament link 19, 319, 419, 519,619 can be conveniently and securely attached to the tibial tray 14,314, 414, 514 or femoral component 612 for supporting movement of theknee joint. Additionally, tension in the ligament link 19, 319, 419,519, 619 can be quickly and conveniently adjusted.

As used herein, the terms superior, superiorly, superior direction areused to generally refer to the anatomical meaning, such as higher inplace or position or generally situated above. Similarly, the termsinferior, inferiorly, inferior direction are used to generally refer tothe anatomical meaning, such as lower in place or position or generallysituated below.

Moreover, the foregoing discussion discloses and describes merelyexemplary embodiments of the present disclosure. One skilled in the artwill readily recognize from such discussion, and from the accompanyingdrawings and claims, that various changes, modifications and variationsmay be made therein without departing from the spirit and scope of thedisclosure as defined in the following claims. For instance, thesequence of the blocks of the method described herein can be changedwithout departing from the scope of the present disclosure.

What is claimed is:
 1. A prosthetic knee joint assembly for a knee jointwith a tibia and a femur, the prosthetic knee joint assembly comprising:a unitary, single body femoral component that is adapted to engage thefemur; at least one bearing that supports articulation of the femoralcomponent thereon; a unitary, single body tibial tray that supports theat least one bearing and that is adapted to engage the tibia; a ligamentlink coupling component included directly on one of the femoralcomponent or the tibial tray; and a ligament link operably coupled tothe one of the femoral component or the tibial tray via the ligamentlink coupling component, the ligament link also extending through theother of the femoral component or the tibial tray to operably couple tothe respective one of the femur or the tibia, the ligament linkextending from a first end to a second end, the ligament link having anouter wall defining an interior longitudinal passage portion, theligament link also having a first aperture passing through the outerwall and disposed between the first and second ends, the ligament linkadditionally having a second aperture passing through the outer wall anddisposed between the first and second ends, the first end extendingthrough the first and second apertures and the longitudinal passageportion to define a first adjustable loop, the second end extendingthrough the first and second apertures and the longitudinal passageportion to define a second adjustable loop.
 2. The prosthetic knee jointassembly of claim 1, wherein the first end also includes a first freeend, wherein the second end also includes a second free end, the firstfree end pullable to reduce a size of the first adjustable loop, thesecond free end pullable to reduce a size of the second adjustable loop.3. The prosthetic knee joint assembly of claim 1, wherein the first andsecond adjustable loops are adjustable to change a tension in theligament link.
 4. The prosthetic knee joint assembly of claim 1, whereinthe ligament link coupling component is included on the tibial tray andincludes a through hole that receives an adjustable loop of the ligamentlink.
 5. The prosthetic knee joint assembly of claim 4, wherein theligament link coupling component has an axis that extends through asuperior surface of the tibial tray and through an inferior surface ofthe tibial tray.
 6. The prosthetic knee joint assembly of claim 1,wherein the ligament link coupling component is included on the tibialtray and includes a groove that nestingly receives a portion of theligament link.
 7. The prosthetic knee joint assembly of claim 6, whereinthe tibial tray includes an inferior, anterior edge, and wherein thegroove is defined on the inferior, anterior edge.
 8. The prosthetic kneejoint assembly of claim 6, wherein the groove has an axis that isadapted to be disposed at a positive, acute angle relative to alongitudinal axis of the tibia.
 9. The prosthetic knee joint assembly ofclaim 1, wherein the ligament link coupling component is disposed on ananterior portion of the tibial tray.
 10. The prosthetic knee jointassembly of claim 1, wherein the ligament link coupling component isincluded on the tibial tray, the ligament link coupling componentincluding an eyelet that selectively closes to secure the ligament linkto the tibial tray and that selectively opens to allow the ligament linkto move into the eyelet.
 11. The prosthetic knee joint assembly of claim1, wherein the tibial tray includes a first ligament link couplingcomponent and a second ligament link coupling component, the first andsecond ligament link coupling components spaced apart at a distance fromeach other.
 12. The prosthetic knee joint assembly of claim 11, whereinthe tibial tray defines a median plane, and the first and secondligament link coupling components are disposed on opposite sides of themedian plane.
 13. The prosthetic knee joint assembly of claim 1, whereinthe ligament link includes a plurality of braided fibers.
 14. Theprosthetic knee joint assembly of claim 1, wherein the ligament linkcoupling component is included on the femoral component, the femoralcomponent including a first condylar portion and a second condylarportion separated at a distance apart to define an intercondylaropening, the ligament link coupling component extending from at leastone of the first and second condylar portions into the intercondylaropening.
 15. The prosthetic knee joint assembly of claim 1, wherein theligament link coupling component is included on the femoral component,and wherein the tibial tray defines an opening through which theligament link extends to couple to the tibia.
 16. The prosthetic kneejoint assembly of claim 15, wherein the tibial tray defines a firstopening and a second opening, the first and second openings disposed onopposite sides of a medial plane of the tibial tray.
 17. The prostheticknee joint assembly of claim 1, wherein the ligament link is adapted toextend through the other of the femoral component or the tibial tray tooperably couple directly to the respective one of the femur or thetibia.
 18. The prosthetic knee joint assembly of claim 1, wherein theligament link is adapted to extend through the other of the femoralcomponent or the tibial tray to operably couple to the respective one ofthe femur or the tibia via a resected anatomical ligament.
 19. Theprosthetic knee joint assembly of claim 1, wherein the first and secondadjustable loops of the ligament link are both coupled to the same oneof the femoral component or the tibial tray.
 20. A prosthetic knee jointassembly for a knee joint of a patient with a tibia and a femur, theprosthetic knee joint assembly comprising: unitary, single body femoralcomponent that is adapted to engage the femur, the femoral componentincluding a medial and lateral condyle portion connected by a patellartrack portion, an intercondylar opening defined between the medial andlateral condyle portions; at least one bearing that supportsarticulation of at least one of the medial and lateral condyle portionsthereon; a unitary, single body tibial tray that supports the at leastone bearing and that is adapted to engage the tibia, the tibial trayincluding a plurality of coupling components, the plurality of couplingcomponents disposed on an anterior portion of the tibial tray, theplurality of coupling components disposed on opposite sides of a medialplane of the tibial tray; and a ligament link operably coupled to thetibial tray via one of the coupling components, the ligament link alsoadapted to couple to the femur, the ligament link extending through theintercondylar opening, the ligament link extending from a first end to asecond end and having an outer wall defining an interior longitudinalpassage portion, the ligament link also including a first aperturepassing through the outer wall and disposed between the first and secondends, the ligament link also including a second aperture passing throughthe outer wall and disposed between the first and second ends, the firstend extending through the first and second apertures and thelongitudinal passage portion to define a first adjustable loop and afirst free end, the second end extending through the first and secondapertures and the longitudinal passage portion to define a secondadjustable loop and a second free end, the first and second free endspullable to increase a tension in the ligament link.